Community Pharmacy of Locust LLC.
Organization Active NPI Community/Retail Pharmacy · Locust, NC
NPI 1184841280 · NPPES record last updated Oct 22, 2018
Key facts
- NPI
- 1184841280
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- COMMUNITY PHARMACY OF LOCUST LLC.
- Practice address
- 236 Market Street
Suite 100
Locust, NC 28097 - Phone
- (704) 888-3784
- Fax
- (704) 781-0026
- NPI assigned
- Apr 19, 2007
- Organization subpart
- No
Authorized official
- Name
- James Mark Richards
- Title
- Vice President
- Phone
- (704) 904-3287
Practitioners 1
-
Amanda Watson, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240220002201 | NC | Part B Supplier - Mass Immunization (Roster Biller Only) | 9739431917 | Practice locations: Locust, NC |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | 09476 | NC | |
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
236 Market Street
Suite 100
Locust, NC 28097
Mailing address
236 Market Street
Suite 100
Locust, NC 28097
Phone (704) 888-3784
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2066164 | Other | PK | |
| 0845420 | Medicaid | NC |
Other names
- Medical Pharmacy of Locust
Other providers in Locust, NC
- Chimere R Callaway
- Carolinas Physicians Network Inc
- Carolinas Physicians Network, Inc.
- Samantha Church
- Clinical and Consulting Solutions PLLC
- Megan Nicole Crinion
- Kyle Wayne Crisco
- Rhonda Lynn Darby
- David E Thome DDS PLLC I
- David E Thome DDS PLLC VIII
All providers in Locust, NC · Community/Retail Pharmacy in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.